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General NPI Number Information
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NPI Number | 1720901341
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Entity Type | Organization
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Legal Business Name | 4ROOTS FOUNDATION, INC.
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Dates
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Enumeration Date | 07/31/2026
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Last Update Date | 07/31/2026
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Provider Practice Location Address
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Address Line | 1918 W PRINCETON ST
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City | ORLANDO
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State | FL
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Zip | 32804-4706
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Country | US
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Telephone | 407-775-6424
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Fax |
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Provider Business Mailing Address
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Address Line | 1918 W PRINCETON ST
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City | ORLANDO
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State | FL
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Zip | 32804-4706
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Country | US
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Telephone | 407-775-6424
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. JAY GROVES
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Credential | EDD
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Telephone | 615-260-0347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332U00000X
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Taxonomy Name | Home Delivered Meals
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License Number |
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License Number State |
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